Provider Demographics
NPI:1194824706
Name:MCKNIGHT, ROSEMARY JANE (MSW, PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:JANE
Last Name:MCKNIGHT
Suffix:
Gender:F
Credentials:MSW, PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 PIERCE ST APT 2204
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1063
Mailing Address - Country:US
Mailing Address - Phone:510-528-2826
Mailing Address - Fax:
Practice Address - Street 1:5299 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-2808
Practice Address - Country:US
Practice Address - Phone:510-547-7455
Practice Address - Fax:510-547-0175
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW116641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01574004/94-3018376Medicaid
CA94-3018376OtherEMPLOYER ID #/TAX ID #